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(Circulation. 2002;105:1526.)
© 2002 American Heart Association, Inc.

Editorials

Women, Heart Failure, and Heart Failure Therapies

Nanette K. Wenger, MD

From Emory University School of Medicine (Professor of Medicine, Cardiology), Grady Memorial Hospital (Chief of Cardiology), and Emory Heart and Vascular Center (Consultant), Atlanta, Ga.

Correspondence to Nanette K. Wenger, MD, Emory University School of Medicine, 69 Butler St, SE, Atlanta, GA 30303. E-mail nwenger@emory.edu

Key Words: Editorial • heart failure • women • sex • trials

The landmark 2001 Institute of Medicine (IOM) report Exploring the Biological Contributions to Human Health: Does Sex Matter?¹ confirmed that significant differences between the sexes affect the prevalence, incidence, and severity of a broad range of diseases and conditions. The report highlighted that sex differences must be considered when designing and analyzing research studies in all areas of biomedical and health-related research, with systematic study and elucidation of sex similarities and differences. The current topic serves as a fine example.

See p 1585

Examination of the underuse of beneficial cardiovascular therapies in women and in elderly persons, often overlapping populations, suggests that under-representation of these cohorts in the randomized clinical trials that provided the evidence for benefit was likely contributory.² Exclusion of women from therapeutic trials of heart failure is exacerbated by exclusion of older participants, as heart failure predominates in older women; women with heart failure were further excluded because they did not have the lower ejection fraction to qualify for enrollment. Such exclusion compromises their quality of care.³ Although the analysis of women in MERIT-HF (Metoprolol Controlled-Release Randomized Intervention Trial in Heart Failure)⁴ reported in this issue of Circulation clarifies one aspect of the hazy landscape of heart failure in women, much remains to be learned.

Post Hoc Analysis of Women in MERIT-HF and Pooling of Mortality Data

Addition of ß-blockers to diuretics, ACE inhibitors, and digoxin is described to improve clinical outcomes, mortality, and hospitalizations. The 23% of women enrolled in MERIT-HF was the only subgroup for whom mortality benefit was not demonstrated. As in other trials where women . . . [Full Text of this Article]

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